Gender differences in health status, quality of life, and community service needs of older adults living alone

Loneliness and functional limitations shaping one another: evidence from the Health and Retirement Study

Objectives: Few studies have examined the bidirectional association between loneliness and functional limitations longitudinally. The current study aimed to explore the causal relationship between loneliness and functional limitations over time (2008 to 2016; T1-T3) using data from the Health and Retirement Study (HRS).

Method: Including 7,046 older American adults (M = 69.17, SD = 10.32) from the HRS, a random intercept cross-lagged panel model (RI-CLPM) was computed to examine carry-over and spill-over effects over time. The RI-CLPMs enable separating the within-person fluctuation from the between-person differences.

Results: The results revealed greater levels of loneliness and a greater number of functional limitations have bidirectional associations at the within-person level from 2012 to 2016. A significant between-person level association was also observed between loneliness and functional limitations, such that greater loneliness levels and greater degree of functional limitations were correlated at the between-person level.

Conclusion: This finding that loneliness and functional limitations shape one another in later life will benefit policymakers, healthcare providers, and researchers in developing targeted interventions and support systems for older adults. Designing interventions addressing both aspects concurrently will enable breaking the potential cycle of negative consequences of loneliness and health among older adults.

Facilitators and barriers faced by community organizations supporting older adults during the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic, olderadult-focused community organizations played an essential role in supporting the wellbeing of older adults. Supporting older adults during this time required extensive modifications to existing programming but their adaptations during the COVID-19 pandemic are not well documented. The purpose of this study was to understand how older adult-focused community organizations adopted virtual delivery formats during the COVID-19 pandemic and their perspectives of the barriers and facilitators for organizations and older adults.

METHODS

To understand the changes that were made, we conducted a qualitative environmental scan of community-based services across British Columbia. Online searches were complemented by snowball sampling and key informant interviews. We identified 90 older adult-serving community organizations and interviewed 26. We used reflexive thematic analysis to understand the main strategies.

RESULTS

These community organizations described barriers related to older adults' wellbeing, information technology proficiency, and personal/organizational losses related to changes in program structure. Facilitators for virtual activities and events included inter- and intra-organizational collaboration, intrinsic qualities of program design, physical resources to supporting virtual programming, and availability of technological resources. Organizations described meeting the challenge by increasing the 'depth' and 'breadth' of their reach.

CONCLUSION

Older adult-focused community organizations recognized the critical role they played for older adults and adapted their resources to meet those needs. Informational technology was quickly and effectively leveraged to promote social interaction for older adults when physical distancing was required during the COVID-19 pandemic. Barriers related to cost, time, and ultimately older adults' interest in a virtual delivery format were critical limitations.

Analysis and Strategies to Improve Living Conditions of Elderly Living Alone in China: A Healthcare Context

Background: The shift toward nuclear family structures in China has resulted in a growing number of elderly individuals living alone, intensifying the imbalance between the supply and demand of elderly care services. Objectives: This study aims to systematically examine the care needs of elderly individuals living alone in China and propose practical strategies to enhance their quality of life. Methods: Using the Kano model and ERG theory, 22 care services were categorized into three types: essential (must-have), attractive, and future-focused (outlook) elements. Survey data were gathered from 230 elderly individuals living alone in Yan'an, Baoji, and Hanzhong, located in Shaanxi Province. To determine the factors influencing the intensity of demand for these services, multivariate ordinal logistic regression analysis was applied. Results: The findings show that demand intensity for care services is significantly shaped by factors such as gender, age, marital status, education level, income, self-rated health, loneliness, and family support. The highest demand was observed for medical and mental health services, followed by life support services. Conclusions: To address the gaps in elderly care services, this study suggests standardizing institutional frameworks, diversifying service options, utilizing familial support networks, and integrating intelligent technologies. These measures are especially critical for reducing service disparities in rural and less developed regions, contributing to a fairer and more effective elderly care system in China.

Gender difference in domain-specific quality of life measured by modified WHOQoL-BREF questionnaire and their associated factors among older adults in a rural district in Bangladesh

BACKGROUND

The global population of older adults has steadily increased in recent decades. Little is known about the gender difference in the quality of life (QoL) of older adults in the general population. This study aimed to identify factors associated with QoL among older adults by gender.

METHOD

Data on QoL using the World Health Organization Quality of Life (WHOQoL-BREF) questionnaire and socio-demographic characteristics, including living status and sources of income, were collected from 1147 older adults. The WHOQoL-BREF has four domains: physical, psychological, social and environmental. Rasch analysis was used to compute a combined score from Likert-type data to a continuous scale ranging from 0% satisfaction to 100% satisfaction in terms of QoL for each domain. We used a generalized linear model to compare the mean rate of QoL for different factors, and logistic regression analysis was used to quantify the associations of factors with below-average QoL measured as 50% or less in QoL.

RESULTS

The domain-specific QoL mean (standard error), minimum-maximum values were physical 48.9 (0.41), 7-86, psychological 38.9 (0.51), 4-71, social 50.5 (0.49), 8-92, and environmental domains 47.8 (0.37), 6-91 in the total sample with significant gender difference in all but social domain. The proportion of below average QoL for females vs. males was physical 47.6% vs. 42.6%, psychological 74.4% vs.66.7%; social 34.8% vs. 30.1% and environmental domains 56.1% vs. 49.0%. In females, participants living alone were associated with a higher proportion of below average QoL in physical OR 30.2, 95% CI 2.47, 370, psychological OR 9.54, 95% CI1.09,83.27 and social domains OR 5.94, 95% CI 1.25,28.34. In males, participants' sources of income from relatives were associated with a higher proportion of below average QoL in physical OR 3.6, 95% CI 2.01,6.44, psychological 30.2, 95% CI 2.47, 370, psychological OR 4.63 95% CI 2.56, 8.38, social domains OR 1.81, 95% CI 1.04, 3.16 and environmental domains OR 2.53 95% CI 1.44, 4.43 than those who had own income. Females engaged in income generation activities had better QoL in social and environmental domains than those with house duties, irrespective of their education or socioeconomic status. Males in retired life had the highest QoL in the social and environmental domains if they had better SES.

CONCLUSIONS

The study's findings reveal that more than 50% of people had below-average QoL in each domain, which is significant. The study also highlighted that females living alone and males without their own income had the poorest QoL. On a positive note, it was found that females engaged in any income generation activities had better QoL in social and environmental domains. These results provide valuable insights for policymakers and healthcare professionals. They underscore the importance of implementing appropriate intervention programs to enhance the QoL of older adults, reiterating the urgency and necessity of their work to improve the health and well-being of older adults.

Predictors of 15-year transitions across living and care settings in a population of Swedish older adults

OBJECTIVE

We aimed to investigate the association of sociodemographic, clinical and functional characteristics with the volume of transitions and specific trajectories across living and care settings.

METHODS

Using data from the Swedish National Study on Aging and Care in Kungsholmen study, we identified transitions across home (with or without social care), nursing homes, hospitals and postacute care facilities among 3021 adults aged 60+. Poisson and multistate models were used to investigate the association between sociodemographic, clinical and functional characteristics and both the overall volume and hazard ratios (HRs) of specific transitions.

RESULTS

Over 15 years, 720 (23.8%) participants experienced between 5 and 10 transitions, and 816 (26.7%) experienced >10 transitions across living and care settings. A higher number of transitions was observed in older participants with multimorbidity and slower walking speed. In contrast, cognitive impairment and disability were associated with a lower number of transitions. After hospital and postacute discharge, each additional year of age (HR range 1.06-1.08) and being a woman compared with being a man (HR range 1.35-4.38) increased the likelihood of discharge to home care. Multimorbidity (HR range 1.14-1.23) and slow gait speed (HR range 1.11-1.50) increased the risk of hospitalisation and home care after hospital discharge. Cognitive impairment raised the hazard of nursing home placement (HR range 1.99-2.15). Disability was associated with a higher hazard of nursing home placement after hospital discharge (HR range 2.57-3.07).

CONCLUSIONS

Accounting for older adults' whole journey across living and care settings, we identified transition-specific predictors and potential triggers that could be timely leveraged to better tailor care to older adults' needs.

Exploring the meaning of a good life for older widows with extensive need of care: a qualitative in-home interview study

INTRODUCTION

Studies of older women's life transitions is rare but gains relevance as the aging population, with older women as the majority, expands.

PURPOSE

To explore the meaning of a good life for older widows with extensive home care needs.

MATERIALS AND METHODS

Semi-structured interviews were carried out with eleven women, aged 80 and over (82-95 years, mean 90) residing at home with extensive care needs (≥4 daily sessions, averaging 2.5-6 hours, mean 3). Data were analysed by reflexive thematic analysis.

RESULTS

The theme "This Day in My Home, the frame of my life" reflects the women's experience of a good life. A good day imbued them with hope, trust and security, carrying them forward with the assurance that night would usher in a new day. However, there were moments when life was merely about navigating daily challenges. During such days, the women felt trapped in time, unsafe and lonely.

CONCLUSION

A day at home may seem static, yet it mirrors life's dynamism, evolving with shifting circumstances. Older widows navigate challenges while maintaining their sense of self, independence, and connection to home. These findings have implications for aged care, recognizing the multifaceted aspects of life and the centrality of home.

Latent class analysis of health lifestyle among older adults living alone and associations with life satisfaction and depressive symptoms

BACKGROUND

Little is known about the collective patterns of health-related behaviors of older adults living alone. We aimed to identify subgroups of older adults living alone based on their health lifestyle and examine the relationship between these subgroups and sociodemographic characteristics, life satisfaction, and depressive symptoms.

METHODS

A total of 3137 older adults living alone were sampled from the 2020 National Survey of Older Koreans. Latent class analysis was performed using 11 health-related behaviors: smoking; alcohol consumption; fruit, vegetable, and dairy product consumption; exercise; cultural leisure; social groups; educational activities; health check-ups; and dementia screening. Multinomial logistic and multiple linear regression analyses were performed.

RESULTS

Three classes were identified: Consistently Healthy (CH), Moderately Healthy but Inactive (MHI), and Unhealthy but Active (UA). Compared to the CH, members of the MHI tend to have no formal education and rarely meet relatives. Members of the UA were more likely to be male and employed. The MHI and UA were more likely to have lower incomes, meet with children less frequently or have no children, and rarely meet friends, neighbors, and acquaintances when compared to the CH. Members of the UA group had the highest risk of reduced life satisfaction and increased depressive symptoms.

LIMITATIONS

The cross-sectional design precluded causal inferences.

CONCLUSION

Our study sheds light on the heterogeneity of health lifestyles among older adults living alone and highlights the need for tailored interventions to promote healthy aging in this population.

Network analysis of the relationships between depressive symptoms and social participation activities among Chinese older adults and its implications for nursing

Objective

Network analysis was used to explore the complex inter-relationships between social participation activities and depressive symptoms among the Chinese older population, and the differences in network structures among different genders, age groups, and urban-rural residency would be compared.

Methods

Based on the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), 12,043 people aged 65 to 105 were included. The 10-item Center for Epidemiologic Studies Depression (CES-D) Scale was used to assess depressive symptoms and 10 types of social participation activities were collected, including housework, tai-chi, square dancing, visiting and interacting with friends, garden work, reading newspapers or books, raising domestic animals, playing cards or mahjong, watching TV or listening to radio, and organized social activities. R 4.2.1 software was used to estimate the network model and calculate strength and bridge strength.

Results

21.60% (2,601/12,043) of the participants had depressive symptoms. The total social participation score was negatively associated with depressive symptoms after adjusting for sociodemographic factors. The network of social participation and depressive symptoms showed that "D9 (Inability to get going)" and "S9 (Watching TV and/or listening to the radio)" had the highest strength within depressive symptoms and social participation communities, respectively, and "S1 (Housework)", "S9 (Watching TV and/or listening to the radio)", and "D5 (Hopelessness)" were the most prominent bridging nodes between the two communities. Most edges linking the two communities were negative. "S5 (Graden work) - D5 (Hopelessness)" and "S6 (Reading newspapers/books) - D4 (Everything was an effort)" were the top 2 strongest negative edges. Older females had significantly denser network structures than older males. Compared to older people aged 65-80, the age group 81-105 showed higher network global strength.

Conclusions

This study provides novel insights into the complex relationships between social participation and depressive symptoms. Except for doing housework, other social participation activities were found to be protective for depression levels. Different nursing strategies should be taken to prevent and alleviate depressive symptoms for different genders and older people of different ages.

Association of the intergenerational structure with the onset of depressive symptoms among middle-aged and older adults in China

BACKGROUND

Chinese family structure has undergone tremendous changes over the past few decades. Moreover, the association of the intergenerational structure with depression remains controversial.

AIMS

This study aimed to find out the association of the intergenerational structure and the onset of depressive symptoms among Chinese middle-aged and older adults.

METHODS

This study included 4,868 participants of the China Health and Retirement Longitudinal Study (CHARLS), who were enrolled in 2011 without depressive symptoms and followed up at least once later in 2013, 2015, 2018, and 2020. Taking the time-varying confounding effect into account, the time-dependent Cox regression models were used to estimate the association of the intergenerational structure and the onset of depressive symptoms.

RESULTS

Among the studied middle-aged and older adults, compared to one-generation households, higher hazard ratios (HR) of developing depressive symptoms were found in three-generation households in the study population (HR = 1.21, 95% CI [1.08, 1.36]). Further, for female participants, skipping-generation households (HR = 1.38, 95% CI [1.05, 1.83]) and three-generation lineal households (HR = 1.21, 95% CI [1.02, 1.43]) were found to be significantly associated with new-onset depressive symptoms compared to empty-nest couples. For male participants, living alone (HR = 1.65, 95% CI [1.30, 2.11]), living in standardized nuclear households (HR = 1.27, 95% CI [1.06, 1.54]), impaired nuclear households (HR = 1.80, 95% CI [1.18, 2.76]), or three-generation lineal households (HR = 1.34, 95% CI [1.12, 1.60]) were found to have a significant association with the onset of depressive symptoms.

CONCLUSIONS

This study found that males living alone, with unmarried children, or in three-generation lineal households, and females living with grandchildren were more likely to suffer from depressive symptoms. Therefore, special attention should be paid to people in these intergenerational structure subtypes.

Biopsychosocial factors of quality of life among middle-aged adults living alone in South Korea: a secondary data analysis using the 2017 Korea Community Health Survey

BACKGROUND

This study aimed to investigate quality of life (QoL) in middle-aged adults living alone and identify comprehensive biological, psychological, interpersonal, and contextual factors related to QoL using the dynamic biopsychosocial model. As a secondary analysis, this study used data from the 2017 Korea Community Health Survey conducted by the Korea Disease Control and Prevention Agency.

METHODS

Among the total 228,381 respondents, 10,639 middle-aged individuals aged 40-64 years from single-person households (5,036 men and 5,603 women) were included in the analysis. QoL was measured using the EuroQoL-5 Dimension (EQ-5D). The EQ-5D descriptive statistics were provided according to biological, psychological, interpersonal, and contextual factors. Considering the data structure of the multistage stratified cluster sampling method, a complex samples general linear model statistic was used to identify the predictors of QoL.

RESULTS

QoL was lower in those who had undesirable psychological status (e.g., more depressive symptoms, poor subjective health, and higher perceived stress), less engagement in social networking (less frequent contact with friends and less frequent participation in social activities such as religious activities, friendship gathering, and leisure), and lower physical, behavioral, and socioeconomic factors.

CONCLUSIONS

This study's findings indicate that psychological and interpersonal factors should be addressed and prioritized to improve the QoL of middle-aged adults living alone. By providing many opportunities for easily accessible social activities that meet the needs and interests of this demographic, their QoL can be improved through strengthening social support.

Nutritional Status and Health-Related Quality of Life among Home-Dwelling Older Adults Aged 75 Years: The PORI75 Study

Malnutrition in older people has been considered as a health concern associated with a range of implications for health and functional ability. However, evidence of nutrition and health-related quality of life (HRQoL) among older people is limited. The aim of this study was to study the associations between nutritional status and HRQoL among home-dwelling older adults aged 75 years. In this cross-sectional study, we studied 75-year-old home-dwelling residents who participated in PORI75 preventive health screenings in 2020 and completed the full Mini Nutritional Assessment (MNA). The participants' HRQoL was measured using the 15D instrument. Altogether, 462 participants (60% women) were included. Of these, 11% had decreased nutritional status (MNA score < 24); 12.7% were women and 8.6% were men, with no difference between the sexes (p = 0.17). A relationship was found between HRQoL and the MNA: a decreased MNA score was associated with decreased HRQoL (p < 0.001, r = 0.45, 95% CI: 0.38 to 0.53). All 15 HRQoL dimensions (except hearing) were associated with the MNA score. Among the men, the association was stronger compared to the women, especially when the MNA score was <24, indicating decreased nutritional status. In conclusion, impaired nutritional status seems to be associated with impaired HRQoL among 75-year-old people living at home, especially among men.

Predicting perceived quality of life through social trust, physical activity, and sense of happiness in Iran: Moderating role of gender

Background and Aims

In Iran, few studies have addressed the moderating effect of gender on determinants of quality of life. This study aimed to determine the effect of social trust, physical activity, and sense of happiness on the perceived quality of life, considering the moderating role of gender.

Methods

This was a population-based cross-sectional study. The statistical population were men and women aged 16 years and above in five western provinces of Iran. The final sample size was estimated to be 1268 people calculated through the correlation coefficient estimation formula, and finally 1185 questionnaires received. Data were analyzed using SPSS and AMOS software.

Results

The mean score of quality of life among women was significantly higher than that of men (p < 0.001). The direct standardized coefficient showed that the sense of happiness (β = 0.40), social trust (β = 0.20), and physical activity (β = 0.12) had a significant effect on the perceived quality of life (p < 0.001). Also, gender had a moderating role in the relationship between sense of happiness and perceived quality of life (z-score = 3.246, p < 0.001). Totally, 21% of the changes in perceived quality of life were explained by three main variables. The main variables were stronger explanatory factors in men (R = 0.26) than in women (R = 0.17).

Conclusions

The final model showed that sense of happiness had the most direct effect on the perceived quality of life, moderated by gender. Considering that the quality of life among men was lower than that among women and the direct effect of happiness on quality of life was more among men than that among women, it is suggested that gender-based health promotion interventions with an emphasis on men be carried out to strengthen the sources of happiness to improve quality of life.

Role of handgrip strength in predicting the quality of life in older adults: A cross-sectional study

BACKGROUND

Quality of life (QOL) is a vital component in assessing the standard of living for seniors. Hand grip strength (HGS) is a widely used measure to diagnose muscle strength decline that often occurs due to age-related loss of skeletal muscle mass and function. This study focuses on the HGS in predicting the QOL of older adults who are referred to retirement centers in Guilan Province.

MATERIALS AND METHODS

In 2021, a cross-sectional analytical study was conducted among 115 older adults who were residing in retirement centers located in Guilan Province, Northern Iran. The participants were selected using a two-stage sampling method, where three retirement centers were randomly chosen followed by convenience sampling from each center. The selected retirement centers were situated in Langrod, Sowme'eh Sara, and Rasht cities in the east, west, and center of the province, respectively. The data were collected through a demographic information questionnaire, QOL scale (CASP-19), and HGS measurement using a dynamometer.

RESULTS

Of the participants, 57.4% were male, 51.3% had middle income, and 96.5% were categorized as young elderly. The mean overall QOL score was found to be 37.026 ± 6.123, while the mean HGS level was 31.74 ± 7.45 and 18.48 ± 5.13 among males and females, respectively. There was a significant association between the level of education and QOL (P = 0.002). Moreover, there was a positive and significant correlation between HGS and QOL (r = 0.54, P = 0.001). The results of the multiple linear regression identified HGS as a predictor of QOL (Adj R2 = 0.44, βHGS = 0.79).

CONCLUSION

Given that HGS has been identified as a predictor of QOL in older adults, improving this factor through exercise can lead to enhancement in their QOL. Therefore, regular sports exercises can be recommended as a means of improving HGS and subsequently enhancing the QOL of older adults.

A network-based approach to explore comorbidity patterns among community-dwelling older adults living alone

The detailed comorbidity patterns of community-dwelling older adults have not yet been explored. This study employed a network-based approach to investigate the comorbidity patterns of community-dwelling older adults living alone. The sample comprised a cross-sectional cohort of adults 65 or older living alone in a Korean city (n = 1041; mean age = 77.7 years, 77.6% women). A comorbidity network analysis that estimates networks aggregated from measures of significant co-occurrence between pairs of diseases was employed to investigate comorbid associations between 31 chronic conditions. A cluster detection algorithm was employed to identify specific clusters of comorbidities. The association strength was expressed as the observed-to-expected ratio (OER). As a result, fifteen diseases were interconnected within the network (OER > 1, p-value < .05). While hypertension had a high prevalence, osteoporosis was the most central disease, co-occurring with numerous other diseases. The strongest associations among comorbidities were found between thyroid disease and urinary incontinence, chronic otitis media and osteoporosis, gastric duodenal ulcer/gastritis and anemia, and depression and gastric duodenal ulcer/gastritis (OER > 1.85). Three distinct clusters were identified as follows: (a) cataracts, osteoporosis, chronic otitis media, osteoarthritis/rheumatism, low back pain/sciatica, urinary incontinence, post-accident sequelae, and thyroid diseases; (b) hyperlipidemia, diabetes mellitus, and hypertension; and (c) depression, skin disease, gastric duodenal ulcer/gastritis, and anemia. The results may prove valuable in guiding the early diagnosis, management, and treatment of comorbidities in older adults living alone.

Differences in quality of life and fitness level among men and women in the adulthood: a cross-sectional analysis

BACKGROUND

This study aimed to examine the associations between physical fitness components and health-related quality of life (HRQoL) among adults stratified by sex and age. In addition, we aimed to examine whether these associations change based on socioeconomic, clinical, and biochemical characteristics.

METHODS

A total of 297 participants aged 47.41 (standard deviation: 9.08) years from the "Validity of a Model of Accelerated Vascular Aging as a Cardiovascular Risk Index in Healthy Adults: the EVasCu cross-sectional study" were included in this analysis. HRQoL, physical fitness, socioeconomic status (SES), waist circumference, and blood pressure were measured. Additionally, blood samples were extracted to determine cholesterol, triglyceride, and glycated hemoglobin A1c (HbA1c) levels. Analyses of covariance (ANCOVAs) were estimated to test mean differences in physical and mental health-related health measures (HRQoL) between fitness categories (fixed factors) by sex and age categories.

RESULTS

The physical HRQoL was related to the levels of fitness parameters among women, independent of age, while for men, it was related to better levels of general fitness and cardiorespiratory fitness among men aged < 50 and men aged ≥ 50, respectively. In contrast, mental HRQoL was related to cardiorespiratory fitness only among women aged < 50 years; speed/agility and flexibility among men aged < 50 years; and general fitness, strength, and flexibility among men aged ≥ 50 years. These data did not change when SES, clinical variables, or biochemical determinations were included in the analyses, neither for the physical nor for the mental HRQoL.

CONCLUSION

Gender and age are important factors to be considered when analysing health indicators and influences in the population. In addition, SES, clinical characteristics, and biochemical parameters do not seem to influence the relationship between HRQoL and fitness.

Effectiveness of community-based interventions for older adults living alone: a systematic review and meta-analysis

OBJECTIVES

This study examined the effectiveness of community-based interventions designed for older adults living alone through a systematic review and meta-analysis.

METHODS

The study incorporated 4 randomized controlled trials (RCTs) and 5 non-RCTs to evaluate various interventions. The methodological quality of these studies was assessed using the Downs and Black checklist, while Q-statistic and I-square tests were performed to examine statistical heterogeneity. Additionally, visual inspection of funnel plots and the trim-and-fill method were employed to investigate potential publication bias. Of the 2,729 identified studies, 9 met the criteria for inclusion in this review. Independent variables were categorized into 5 groups (physical activity, nutrition, social relationships, social participation, and combined intervention) to examine their effects. Dependent variables were similarly classified into 5 subgroups to identify the specific effects of the interventions.

RESULTS

Interventions focusing on nutrition and combined approaches were the most effective, yielding effect sizes of 0.96 (95% confidence interval [CI], 0.66 to 1.25) and 0.43 (95% CI, 0.26 to 0.60), respectively. The interventions had the greatest impacts on the health behavior and mental health of the participants, with effect sizes of 0.98 (95% CI, 0.73 to 1.22) for health behavior and 0.67 (95% CI, 0.19 to 1.16) for mental health.

CONCLUSIONS

This study suggests a direction for the development of community-based interventions tailored to the needs of older adults living alone. Additionally, it provides evidence to inform policy decisions concerning this demographic.

Changes in the health status and health-related quality of life of community-dwelling older adults living alone: one-year follow-up from a cohort study

Background

The percentage of older adults living alone is rapidly increasing, improving the health status and health-related quality of life (HRQoL) in this group is becoming a more significant public health issue. This study aimed to examine the changes in the HRQoL of older South Korean adults living alone and identify the factors that affect their HRQoL.

Methods

A longitudinal study design was followed. Data were collected at baseline and 1-year follow-up. Participants consisting of 789 older adults living alone in S*City aged>65 years completed a cohort survey regarding health status and HRQoL from August 2018 to August 2019. Trained interviewers conducted face-to-face interviews with the participants using a validated questionnaire (physical health, mental health, social health, and HRQoL). Generalized estimating equations were used to assess the change in health status and the interaction effect of time and gender. Then, a stepwise multiple logistic regression analysis was performed to identify factors related to HRQoL.

Results

Time differences were observed in the subjective evaluation of health status (SEH), IPAQ scores, frailty, nutritional status, and depression. Gender differences were observed in the SEH, IPAQ, frailty, loneliness, depression, and social support. The interaction between time and gender was observed in the IPAQ and HRQoL. At baseline, SEH, depressive symptoms, gender, frailty, and age were associated with HRQoL. After one year, HRQoL was associated with SEH, frailty, depressive symptoms, cost of living, suicidal thoughts, gender, social support, loneliness, and suicide attempts.

Conclusion

Our results highlight that HRQoL is associated with physical health, mental health, and social support. Future detailed studies are needed to determine whether governments and communities can prevent depression, loneliness, and suicidal thoughts through psychological support and provide economic support to improve the quality of life of older adults living alone.

Driving the determinants of older people's mental health in the context of urban resilience: a scoping review

BACKGROUND

Population aging is a pervasive phenomenon occurring rapidly worldwide, while sustainable development goals are considered the mental health among older adults.

METHODS

To investigate the factors affecting mental health, we conducted a scoping review of the 47 papers published between 2015 and 2022 to explore various dimensions affecting older adults' mental health.

RESULTS

Our finding mirrors four dimensions of creating healthy and sustainable environments for older adults: person, place, processes, and resilience-related health in the living environment. The person dimension includes individual characteristics, attitudes and behaviors, and health status. The place dimension is divided into five categories: land use, access, physical form, public open spaces, and housing, while the process consists of the social, cultural, and economic environments. Resilience-related health dimension emphasizes the impact of natural and man-made disasters on older people's mental health.

DISCUSSION

These findings can provide policymakers insights into developing community-based environmental intervention strategies to promote mental health among older adults and support healthy and active aging.

Factors related to subjective well-being among community-dwelling older adults living alone: A stratified analysis by sex and marital status from the JAGES

BACKGROUND

Previous cross-sectional studies suggest that negative health outcomes such as mortality, social isolation, loneliness, and depression among older adults living alone vary by sex and marital status, with men often worse off than women and unmarried people worse off than married people. However, limited evidence exists from longitudinal studies regarding whether positive health outcomes such as subjective well-being (SWB) also vary by sex and marital status. The focus by sex and marital status on the positive health outcomes and diverse profiles of older adults living alone is important for public health in the near future. Therefore, the purpose of this study was to identify changes in SWB over time and its associated factors by sex and marital status among older adults living alone in the community using a longitudinal study in a representative population.

METHODS

This was a longitudinal study using data from the Japan Gerontological Evaluation Study. This study is the first to reveal differences in SWB and related factors over 3 years among older adults living alone in the community (n = 8,579) who were stratified by sex and marital status (married men, non-married men, married women, and non-married women).

RESULTS

Women moved to higher levels of SWB than did men, and married individuals moved to higher levels of SWB than did unmarried individuals. Independent functioning factors and interpersonal factors were significantly associated with SWB for married men and married women, but for unmarried women, the association by interpersonal factors was more pronounced, and for unmarried men, only limited emotional support and health promotion activities were significant among the interpersonal factors.

CONCLUSIONS

This study revealed that among older adults living alone, changes in SWB over time and the independent functioning factors and interpersonal factors associated with this change varied by sex and marital status among older people living alone. These findings are useful for policy-making and guiding intervention activities to promote SWB in a society in which the environment for older adults living alone is changing dramatically.

Gender-specific association of loneliness and health care use in community-dwelling older adults

BACKGROUND

Loneliness in older adults is common, particularly in women. In this article, gender differences in the association of loneliness and health care use are investigated in a large sample of community-dwelling older adults.

METHODS

Data of 2525 persons (ages 55-85 years)-participants of the fourth follow- up (2011-2014) of the ESTHER study- were analyzed. Loneliness and health care use were assessed by study doctors in the course of a home visit. Gender-specific regression models with Gamma-distribution were performed using loneliness as independent variable to predict outpatient health care use, adjusted for demographic variables.

RESULTS

In older women, lonely persons were shown to have significantly more visits to general practitioners and mental health care providers in a three-month period compared to less lonely persons (p = .005). The survey found that outpatient health care use was positively associated with loneliness, multimorbidity, and mental illness in older women but not in older men. Older men had significantly more contact with inpatient care in comparison to women (p = .02).

CONCLUSIONS

It is important to consider gender when analyzing inpatient and outpatient health care use in older persons. In older women loneliness is associated with increased use of outpatient services.

Relationship between Social Capital and General Health among the Iranian University Students: A Cross-Sectional Study

The most basic axis of a society's economic and social growth is health, and social capital is a major factor in determining that development. The purpose of this research was to evaluate, among the student body of Iran University of Medical Sciences, the connection that exists between social capital and overall health. This study used a descriptive-analytical approach to cross-sectional research. Students attending the Iran University of Medical Sciences constituted the statistical population. The approach developed by Cochran was used to pick 367 students at random. The demographic information form, two versions of the Delaviz Social Capital Questionnaire (2006), and Goldberg and Hiller's General Health Questionnaire (1979), served as the data collection tools. Using Cronbach's alpha test, the reliability of the first two sets of questionnaires was determined to be 0.73 and 0.78, respectively. The data were analyzed using descriptive statistics, statistical tests, and regression after being loaded into SPSS version 22. It was shown that general health was significantly related to the factors of gender, location of living, and degree of education (p < 0.05). It was shown via the use of regression that there is a statistically significant association between social capital and the two dimensions of group involvement and relationships in networks. These two dimensions had the biggest influence on general health and explained 39% of its variations. The overall health of students was not significantly affected by factors such as age, educational level, or marital status (p > 0.05). It is feasible to improve students' overall health if social capital is increased, more students are encouraged to participate in group projects, and students' ties with one another inside and outside their networks are expanded.

Latent profile analysis of depression among older adults living alone in China

BACKGROUND

The number of older adults living alone has increased significantly. Depression is one of the significant mental health problems they face; classifying depressive conditions into homogeneous subgroups can help discover hidden information.

METHODS

The data comes from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Latent profile analysis (LPA) was used to identify depression subgroups among elderly living alone, Chi-square tests and Kruskal-Wallis tests were used to univariate analysis, multinomial logistic regression was used to analyze the related factors.

RESULTS

1831 older adults living alone were identified and classified as low-level (30.4 %), moderate-level (55.3 %) and high-level (14.4 %). All variables, except age, were significant in the univariate analysis. Multinomial logistic regression showed that not participating in exercise, sometimes interacting with friends, anxiety symptoms, and impaired IADL were associated with the moderate- and high-level of depression in older adults living alone; good or fair self-rated health and life satisfaction were associated with the low-level of depression in older adults living alone. Anxiety symptoms were associated with high-level of depression in older adults living alone compared to moderate-level; good or fair self-rated health and life satisfaction were associated with moderate-level of depression in older adults living alone.

LIMITATIONS

The CES-D-10 cannot fully determine the presence of depression in elderly people living alone at high-level.

CONCLUSIONS

In future primary health care, it would be more meaningful to provide targeted interventions for different subgroups of depression in older adults living alone.

Sleep, physical activity, and sedentary behaviors as factors related to depression and health-related quality of life among older women living alone: a population-based study

BACKGROUND

Although the number of older women living alone (OWLA) has risen steadily in aging societies, and research has been conducted on depression and health-related quality of life (HRQoL) among older adults, research is scarce on the health behaviors of OWLA, including their sleep, physical activity, and sedentary behaviors. Hence, we aimed to identify factors related to depression and HRQoL among this subset of the population, focusing on their health behaviors, using Andersen's model as a research framework.

METHODS

Data for secondary analysis were from the Korean National Health and Nutritional Examination Survey (2014, 2016, 2018, and 2020). The inclusion criteria were (1) women aged 65 and older and (2) those living alone. We included 794 older South Korean women living alone from 31,051 respondents. We used hierarchical regression analysis, considering sampling weight and a complex sample design, to identify factors related to depression and HRQoL.

RESULTS

Among the health behavior factors of Andersen's model as a research framework, sleep was associated with depression, whereas physical activity and sedentary behaviors were related to HRQoL. Subjective health status, limited activity, and perceived stress were associated with both depression and HRQoL. Household income, as an enabling factor, was only associated with HRQoL. The final regression model explained 39% of the variance in depression (p < 0.001) and 37% of the variance in HRQoL (p < 0.001).

CONCLUSIONS

Our study highlights the importance of strategies to improve specific healthy behaviors that affect depression and HRQoL in OWLA. Appropriate interventions that target increasing physical activity and quality of sleep, and decreasing sedentary behaviors, will be effective to enhance the well-being of OWLA. Healthcare providers should comprehensively understand the characteristics of OWLA and pay more attention to enabling, need, and health behavior factors.

Living alone and cardiovascular outcomes: a meta-analysis of 11 cohort studies

To explore whether living alone could increase the risk of cardiovascular outcomes. We searched PubMed, EMBASE, and Web of Science from their inception to 5 October 2020. Cohort studies evaluating the relationship between living alone and cardiovascular outcomes were included. Subgroup analyses were conducted to explore which characteristics would affect the relationship. A total of 13 effect sizes obtained from 11 studies were included and spanned from 1993 to 2019, with 424,286 participants. This study found that living alone increased the risk of cardiovascular outcomes (HR = 1.22, 95% CI: 1.10-1.36, I² = 80.3%, P = 0.000). In subgroup analyses, living alone increased the risk of cardiovascular outcomes in patients from Europe (HR = 1.37, 95% CI: 1.17-1.61, I² = 76.2%, P = 0.000), but not increased in Asia (HR = 1.17, 95% CI: 0.83-1.66, I² = 76.2%, P = 0.000) and multiple regions (HR = 1.02, 95% CI: 0.96-1.08, I² = 0.0%, P = 0.738). For different cardiovascular outcomes, living alone has statistical significance in increasing the risk of cardiovascular mortality (HR = 1.23, 95% CI: 1.05-1.46, I² = 84.0%, P = 0.000) and myocardial infarction (HR = 1.11, 95% CI: 1.02-1.21, I² = 29.6%, P = 0.213). The risk of cardiovascular mortality in men was higher than women (HR = 1.52, 95% CI: 1.24-1.86 vs HR = 1.01, 95% CI: 0.85-1.20; P < 0.05 for interaction). Sensitivity analysis suggested that the results of the meta-analysis were robust. In conclusion, living alone could increase the risk of cardiovascular outcomes and men were more prone to cardiovascular mortality and myocardial infarction.

Investigation of long-term COVID-19 patients' quality of life and affecting factors: Data from single COVID-19 follow-up center

Background

Patients with COVID-19 experienced changes in their quality of life. However, far less is known about how quality of life changes in long-term COVID-19 follow-ups.

Aim

This article aims to explore the relationship between quality of life change and long-term COVID-19 patient status in the COVID-19 follow-up center.

Patients and Methods

This study was designed retrospectively with patients admitted to the COVID-19 follow-up center between January and May 2021. The single group consisted of 125 patients. Their status and 36-Item Short-Form Health Survey (SF-36) variables were compared at two different time intervals. The first admission indicates the first 3 months, and the second admission covers 3-6 months after being diagnosed with COVID-19.

Results

Cough and chest pain increased in the second admission (P < 0.001). No significant differences were found in SF-36 change according to age. The general health subgroup scores were lower in females than males (P = 0.004). The SF-36 Form's subgroups for physical function, physical role, emotional role, bodily pain, energy, mental health, general health, and social function showed improvement (P = 0.001, P = 0.001, P = 0.026 P < 0.001, P = 0.007, P = 0.031, P <0.001, P <0.001, respectively). In addition, comparing with the SF-36 subgroups in terms of treatment places, a significant result was found between the inpatient and intensive care unit (ICU) in the general health subgroup (P = 0.044).

Conclusions

The results show that quality of life may worsen during follow-up for COVID-19. In summary, these findings have significant implications for understanding long-term COVID-19 patients with a multidisciplinary approach and the necessity of follow-up centers to detect the unpredictable results of long-term COVID-19.

Social engagement and subjective health among older adults in South Korea: Evidence from the Korean Longitudinal Study of Aging (2006-2018)

Background

Social engagement serves as the foundation for social connections by providing a sense of belonging, social identity, and fulfillment. Previous studies have mainly focused on the one-way relationship between social engagement and subjective health among older individuals, and little attention has been paid to their mutual relationship. Therefore, this study aimed to examine the mutual association relationship between social engagement and their subjective health in older Koreans.

Methods

Seven waves of data samples (aged ≥60 years) from 2006 to 2018 from the Korean Longitudinal Study of Aging (KLoSA) was used in this study. Descriptive analysis, chi-squared tests, 2-year lagged Generalized estimating equation (GEE) model, and cross-lagged panel model were performed to investigate the mutual association between social engagement and subjective health among six survey periods.

Results

Results of the GEE model revealed when controlling for other variables, older Koreans who reported good subjective health only had a higher OR (1.678 vs. 1.650, p < 0.001) of participating in social engagement than those who had bad subjective health in 2006-2008 period; the occurrence rate of more social engagement was significantly higher among older adults with good subjective health than among those with bad subjective health (five out six survey periods). Cross-lagged analysis showed similar results that coefficients of social engagement on subjective were relatively larger in three survey periods; coefficients of subjective health on social engagement were relatively larger in the other three survey periods. The impact of social engagement on subjective health might be greater than that of subjective health on social engagement.

Conclusion

All-around participation and engagement of older people in society have become a consensus among the international community. In view of the single social engagement activities and less relevant participation channels in Korea, government departments should consider not only regional but also local characteristics to create more social participation opportunities for older individuals.

Association between multimorbidity patterns and catastrophic health expenditure among Chinese older adults living alone

BACKGROUND

Multimorbidity is prevalent among older adults and may result in catastrophic health expenditures (CHEs) on older adults' households. However, whether older adults living alone suffer such a financial burden is unknown. We aimed to investigate the association between multimorbidity patterns and CHE in Chinese older adults living alone.

METHODS

We included 884 participants aged 60 years and over and living alone from the 2018 wave of the China Health and Retirement Longitudinal Study (CHARLS). Latent class analysis was performed to identify multimorbidity patterns based on 14 self-reported chronic diseases. The logit model and Tobit model were adopted to analyze the association of multimorbidity patterns with the incidence and intensity of CHE, respectively.

RESULTS

Approximately 20.2% of the older adults living alone experienced CHE. Among the four multimorbidity groups (minimal disease, cardiovascular, lung and asthma, and multisystem), the multisystem group and cardiovascular group had significantly higher incidence and intensity of CHE than the minimal disease group.

CONCLUSIONS

Older adults living alone had high risks of CHE, especially those belonging to the multisystem pattern and cardiovascular pattern. Integrated care should be adopted in the treatment of multimorbidity to reduce health costs. More elder services and social assistance should be provided to solitary older adults with certain patterns of multimorbidity.

Are Your Participants Real? Dealing with Fraud in Recruiting Older Adults Online

The internet offers exciting opportunities for quick, cost-efficient, and widespread recruitment and data collection without face-to-face contact. Previous research has demonstrated success in reaching population subgroups not typically included in traditional recruitment methods, yet challenges in data quality protection remain paramount. This article describes using Amazon Mechanical Turk, Facebook groups, and email distribution lists to recruit older adults who live alone for a quantitative study using a cross-sectional online survey. Fraudulent survey takers became a major concern in this study, and a protocol was developed to identify and exclude suspicious data. Of 738 recorded participants, 117 responses were retained in the final sample. The majority of sham responses were collected from Facebook with the fewest number of issues identified in responses collected via targeted emailing. Implications for survey design, data analysis, and future research are discussed.

Patterns of smoking and menopause-specific quality of life: smoking duration matters more

Evidence about the association of quantity of cigarettes smoked and duration of smoking with quality of life in menopause is sparse. The purpose of this study was to examine the association between smoking patterns and menopause-specific quality of life. This cross-sectional study included 513 consecutive midlife women at two primary health care centers in Belgrade, Serbia. Collection of data was carried out from February 2014 to January 2015, using three questionnaires: socio-epidemiologic questionnaire, Menopause-specific Quality of Life questionnaire (MENQOL) and Beck's Depression Inventory (BDI). Women reported their smoking status (smoker, former smoker, non-smoker), the length of time spent smoking and quantity of cigarettes smoked per day. There was no difference in proportions of ever smokers compared to never smokers. However, there were more women who were current nonsmokers than current smokers. A linear regression model, adjusted for residency district, relationship status, educational level, employment, drinking alcohol, having exercise, age and BDI, showed that longer duration of smoking, but not number of cigarettes smoked per day, was associated with worse Physical domain and total MENQOL score. Receiver Operating Characteristic analysis showed that menopausal symptoms as measured by total MENQOL score were significantly less bothersome for women who smoked less than 10 years and significantly more intense in women who smoked 21 to 30 years. Midlife women should be encouraged to quit smoking as soon as possible, preferably before menopause. Strategies to prevent and quit smoking should be prioritized at all levels of health care delivery for women.Supplemental data for this article is available online at.

The Relationship of Neighborhood Walking Behavior to Duration of Aging in Place-A Retrospective Cohort Study

The benefits of physical activity on health are widely known. However, the impact of physical activity on aging-in-place at home for older adults is unclear. Focusing on older adults who recently moved from home to a senior-living facility, this research explored the impact of walking on the ability to age-in-place. Data were collected through a questionnaire survey completed by residents in 12 assisted-living facilities in Houston, Texas. Controlling for significant personal factors, ANOVAs were applied. Non-Hispanic White older adults (N = 124) who used canes or no aids and engaged in 30 min to 1 h of walking per occurrence were able to remain in their homes for an average of 17.84 years after age 65, 1.85 years longer than their counterparts who walked less than 30 min per occurrence. Those who walked for more than an hour per occurrence remained at home for 22.71 years on average, 6.72 years longer than their counterparts (p ≤ 0.05). Engaging in neighborhood walking may help older adults maintain more years of aging-in-place at home. The findings have a direct impact on both public health programs and community design and planning strategies promoting aging-in-place.

Gender-based depression factors of older adults living alone during the COVID-19 pandemic: A cross-sectional and secondary data approach

The coronavirus disease 2019 (COVID-19) pandemic negatively affected the mental health of older adults living alone. This study aimed to examine the differences in factors that influence depression among older adults based on gender. This study was a cross-sectional study employing the secondary data of 3581 older adults living alone at the early stage of COVID-19, collected from the 2020 Korea Community Health Survey, and used multiple linear regression analyses to identify factors associated with depression. We found that women had a higher level of depressive status than men. Low subjective health status was most significantly related to depression in both older men and older women. For women, body mass index and more changes in daily life due to COVID-19 were predictors of depression. Conversely, for men, a lower level of monthly income and smoking were significant predictors of depression. Depressive status caused by COVID-19 was likely to be frailer for older women who were living alone. There were differences in the factors related to depression due to COVID-19 by gender.

New Dimension on Quality of Life Differences among Older Adults: A Comparative Analysis of Digital Consumption in Urban and Rural Areas of China

The purpose of this study was to compare the variability in quality of life in the area of digital consumption among older adults in urban and rural China during the COVID-19 pandemic. This study proposed a low-cost mixed research method, and the methodology used a quantitative study of a large regional sample combined with a qualitative study of a small regional sample. Data for the large-scale area sample were obtained from the China family panel study (CFPS) dataset, and data for the small-scale regional sample were obtained from Nanjing, China. The quantitative analysis of the large-scale regional sample used the least squares regression analysis (OSL) and propensity score matching (PSM). The qualitative analysis of the small-scale regional sample used the selection optimization and compensation (SOC) model. The findings show that economic income is a direct driver of digital consumption. Digital consumption had a significant positive relationship with the quality of life for urban and rural older adults. In addition, the study established the semantic network relationships of the coping strategies of digital consumption of older adults and their drivers. Finally, the theoretical and practical implications of these findings are discussed in the context of other related studies.

Correlates of quality of life, happiness and life satisfaction among European adults older than 50 years: A machine-learning approach

BACKGROUND AND OBJECTIVES

Previous research has documented the role of different categories of psychosocial factors (i.e., sociodemographic factors, personality, subjective life circumstances, activity, physical health, and childhood circumstances) in predicting subjective well-being and quality of life among older adults. No previous study has simultaneously modeled a large number of these psychosocial factors using a well-powered sample and machine learning algorithms to predict quality of life, happiness, and life satisfaction among older adults. The aim of this paper was to investigate the correlates of quality of life, happiness, and life satisfaction among European adults older than 50 years using machine learning techniques.

RESEARCH DESIGN AND METHODS

Data drawn from the Survey of Health, Ageing and Retirement in Europe (SHARE) Wave 7 were used. Participants were 62,500 persons aged 50 years and over living in 26 Continental EU Member States, Switzerland, and Israel. Multiple machine learning regression approaches were used.

RESULTS

The algorithms captured 53%, 33%, and 18% of the variance of quality of life, life satisfaction, and happiness, respectively. The most important categories of correlates of quality of life and life satisfaction were physical health and subjective life circumstances. Sociodemographic factors (mostly country of residence) and psychological variables were the most important categories of correlates of happiness.

DISCUSSION AND IMPLICATIONS

This study highlights subjective poverty, self-perceived health, country of residence, subjective survival probability, and personality factors (especially neuroticism) as important correlates of quality of life, happiness, and life satisfaction. These findings provide evidence-based recommendations for practice and/or policy implications.

Scoliosis Research Society-22r score is affected by standing whole body sagittal alignment, age, and sex, but not by standing balance or skeletal muscle mass in healthy volunteers

PURPOSE

Aging and spinal disease impair standing whole body sagittal alignment (WBS alignment), which leads to stooping. When WBS alignment deteriorates, compensatory mechanisms are activated to maintain standing posture. Increase of the compensation impairs health-related quality of life (HRQOL). The purpose of this research was to determine whether postural factors, age, and sex affect HRQOL.

METHODS

This cross-sectional study evaluated the influence of WBS alignment, standing body sway (balance), skeletal muscle mass (SMM), aging, and sex on HRQOL in healthy volunteers (n = 150; mean age 40.9 years [20-76], 96 women). Age, sex, weight, height, and body mass index (BMI) were obtained. HRQOL was assessed with Scoliosis Research Society-22 (SRS-22r). WBS alignment and balance were measured by EOS imaging with simultaneous force plate measurement. SMM was measured using a medical body composition analyzer. Based on the bivariate analysis between the SRS-22r subtotal and all parameters, selected ten parameters were used for multivariate logistic regression analysis to identify affecting factors to SRS-22r.

RESULTS

Men had significantly higher weight, height, BMI, and SRS-22r score in all domains. The L4-S1 lumbar lordosis angle was greater in men, and pelvic tilt and knee hyperextension were greater in women. Women had a more stable standing posture, whereas men had significantly higher SMM values. Multivariate logistic regression analysis revealed that age, sex, and TPA were identified as significant factors affecting SRS-22r.

CONCLUSIONS

In healthy volunteers, SRS-22r is affected by aging, sex (woman had a lower score), and sagittal malalignment. Neither Standing balance nor SMM, however, affect SRS-22r.4.

Feasibility and efficacy of TouchCare system using application for older adults living alone: a pilot pre-experimental study

BACKGROUND

With the number of older people living alone continuously rising, health-monitoring systems using information and communication technology (ICT) have been developed to manage their health issues. Life logging and human body communication sensor, types of ICT, have been adapted to manage and monitor health status of the elderly. However, its feasibility and efficacy remain unclear. This study aimed to examine the feasibility of TouchCare system which combined life logging with human body communication technology and its effect on the physical and psychological status of older adults living alone.

METHODS

The TouchCare system, which consisted of a wearable watch, touchpad sensors, TouchCare application, and context-aware artificial intelligence, was developed by DNX Co. Ltd and used by the participants for 5 months. Out of the 111 selected participants, 91 replied to the satisfaction survey, and 22 participated in further investigation regarding their physical and psychological status. Finally, health assessment from 14 participants and sensor data from 13 participants (mean age = 77.4; SD = 3.8) were analyzed to compare their health status and health-related behaviors before and after use of the system.

RESULTS

Out of the 91 participants who took the survey, 51.6% were satisfied with the system. Nutritional status (pre-intervention (10.6 ± 2.0) vs. post-intervention (11.8 ± 1.9), P = 0.04) and fall efficacy (pre-intervention (89.2 ± 15.3) vs. post-intervention (99.9 ± 0.5), P = 0.001) significantly improved after use of the system. Chronic pain (pre-intervention (4.8 ± 2.5) vs. post-intervention (4.4 ± 3.7), P = 0.78) and depressive symptoms (pre-intervention (5.7 ± 3.9) vs. post-intervention (5.4 ± 3.1), P = 0.60) reduced, while cognitive function (pre-intervention (4.1 ± 1.4) vs. post-intervention (4.6 ± 1.1), P = 0.15) and physical performance related to walking improved (pre-intervention (3.9 ± 0.2) vs. post-intervention (4.0 ± 0), P = 0.35), but were not significant. Behaviors related to physical activity and gait improved after use of the system; touch counts of refrigerator and microwave also increased with a decrease in night touch counts.

CONCLUSIONS

The TouchCare system was acceptable to older people living alone, and it efficiently managed their daily living while promoting their health-related behaviors. Further experimental studies are required to verify the effectiveness of the system, and to develop the system which meet the individualized needs of older people living alone.

Current and past factors affecting the quality of aging in a sample of Spanish elderly

Aging is a multifactorial process influenced by both biological and sociocultural factors. The objective of this study was to identify current and past factors with an impact on the quality of aging in a sample of people 65 years of age or older born in the postwar period after the Spanish civil war. Socioeconomic, health, anthropometric, and food consumption data were collected in public Leisure Centers for the elderly in Madrid. The sample consists of 587 people (64.6% women), with a mean age of 71.8 ±5.3 years. Following the World Health Organization (WHO) guidelines regarding what is considered Healthy Aging, an index called the Index of Quality of Aging was calculated from four variables: the Mini Mental State Examination score, perception of health, satisfaction with life and the number of diseases that affect daily life. Another index called the Diet Inflammation Index was created based on the inflammatory or anti-inflammatory potential of different foods. The Index of Quality of Ageing was used as a dependent variable in linear regression models for men and women. Differences by gender were observed in the factors that influence the quality of aging. Education had a positive influence on men quality of ageing while it does not on women. In these, a relationship between the quality of the current diet and the quality of aging was observed.

Frequency and gender differences in the use of professional home care in late life. Findings from three German old-age cohorts

Aim

The aim of this study was to investigate the frequency of and the gender differences in the use of professional home care in Germany.

Methods

We used harmonized data from three large cohort studies from Germany (“Healthy Aging: Gender-specific trajectories into the latest life”; AgeDifferent.de Platform). Data were available for 5,393 older individuals (75 years and older). Mean age was 80.2 years (SD: 4.1 years), 66.6% were female. Professional homecare outcome variables were use of outpatient nursing care, paid household assistance, and meals on wheels' services. Logistic regression models were used, adjusting for important sociodemographic variables.

Results

Altogether 5.2% of older individuals used outpatient nursing care (6.2% women and 3.2% men; p &lt; 0.001), 24.2% used paid household assistance (26.1% women and 20.5% men; p &lt; 0.001) and 4.4% used meals on wheels' services (4.5% women and 4.0% men; p = 0.49). Regression analysis revealed that women had higher odds of using paid household assistance than men (OR = 1.48, 95% CI: [1.24–1.76]; p &lt; 0.001), whereas they had lower odds of using meals on wheels' services (OR = 0.64, 95% CI: [0.42–0.97]; p &lt; 0.05). No statistically significant differences in using outpatient nursing care between women and men were found (OR = 1.26, 95% CI: [0.87–1.81]; p = 0.225). Further, the use of home care was mainly associated with health-related variables (e.g., stroke, Parkinson's disease) and walking impairments.

Conclusions

Our study showed that gender differences exist in using paid household assistance and in culinary dependency. For example, meals on wheels' services are of great importance (e.g., for individuals living alone or for individuals with low social support). Gender differences were not identified regarding outpatient nursing care. Use of professional home care services may contribute to maintaining autonomy and independence in old age.

Structural equation model of the relationship between functional ability, mental health, and quality of life in older adults living alone

Aims

Living alone, a reality in an increasing number of older adults recently, is a risk factor for low quality of life. This study identified the predictors of quality of life in older adults living alone based on mental health and the International Classification of Functioning, Disability, and Health.

Methods

This secondary data analysis used information from the 2018 Assessing the Requirements of Customized Health Care and Daily Living Support Services survey (N = 1,022), collected from adults aged ≥ 65 living alone in Siheung City, South Korea, from August to October 2018. The exogenous variables were body functions (hand grip strength, timed “up and go” test score, and body mass index), daily living activities (Korean Instrumental Activities of the Daily Living Scale), social activity participation (social activity engagement, neighbor contacts, and family contacts), and participation in economic activity (frequency). The endogenous variables were mental health (Geriatric Depression Scale Short Form—Korean Version and UCLA Loneliness Scale) and quality of life (EuroQoL-5 Dimension-3 Level and EuroQoL-Visual Analog Scale).

Results

After modifying the hypothetical model, which had failed to satisfy the recommended fitness level, the (modified) model had good fitness indices Q (CMIN / df) 2.90, GFI 1, AGFI 1, RMSEA 0.04, CFI 0.90 and PCFI 0.53. Of the nine pathways of the modified model, five were statistically significant. Quality of life was affected by body functions, daily living activities, social activity participation, and mental health. These variables explained 68.2% of the factors affecting quality of life.

Conclusions

By highlighting the role of mental health, this model provides a useful framework for improving the quality of life of older adults who live alone and function at various levels in the community. Focusing on advancing mental health through body functions, daily living activities, and social activity participation can improve quality of life.

Impact of COVID-19 on the social relationships and mental health of older adults living alone: A two-year prospective cohort study

Background

Owing to the COVID-19 outbreak, older adults living alone, who can only connect socially outside their homes, are at risk of social isolation and poor mental health. This study aimed to identify the changes, before and after COVID-19, by sex and age, in social relationships (social activity, social network, and social support) and mental health (depression and suicide ideation) among older adults living alone.

Methods

This is a prospective cohort study of community-dwelling older adults who were at least 65 years old and living alone in South Korea. The study was conducted during 2018–2020 with 2,291 participants (795, 771, and 725 for the 1st to 3rd waves, respectively). The data were collected via face-to-face interviews. A generalized linear mixed modeling framework was used to test for changes over three years.

Results

Social activity was reduced after the COVID-19, with an interaction effect of sex: older women (odds ratio [OR], 0.19; 95% confidence interval [CI], 0.15–0.23; p < .001) showed greater reduction than older men (OR, 0.50; 95% CI, 0.34–0.75; p < .001). Interaction with neighbors also reduced after the pandemic, but there was no significant evidence of interaction effects. Interaction with family members increased in both sexes during the pandemic, with the interaction effect of sex: older women (OR, 1.40; 95% CI, 1.11–1.76; p = .004) showed greater increase than men (OR, 1.55; 95% CI, 1.13–2.14; p = .007). Social support increased in both sexes during the pandemic, but there was no significant evidence of interaction effects. Depression and suicide ideation showed no significant differences before and after the pandemic.

Conclusions

The findings provide health administrators and health providers with explorative insights into the impact of the COVID-19 on social relationships and mental health among older adults living alone and can guide further studies of interventions considering specific properties of social relationships.

Social Frailty and Health-Related Quality of Life in Community-Dwelling Older Adults

This study aimed to identify the association between social frailty and health-related quality of life (HRQoL) and to identify the factors influencing HRQoL in community-dwelling older adults in South Korea. This was a secondary analysis of a cross-sectional survey study of 735 older adults. HRQoL was measured using the EuroQoL-5 Dimension, and social frailty was measured using five items. The differences in HRQoL according to sociodemographic characteristics, health-related characteristics, and social frailty of subjects were tested using the Mann−Whitney test, Kruskal−Wallis test, and χ2 test. A Tobit regression model was used to identify the influencing factor of HRQoL. About 31.0% of the older adults were in a social pre-frailty state, and 48.4% were in a social frailty state. Of the five components of social frailty, going out less compared to the previous year and being alone were frequently observed. Older adults who had social frailty had lower HRQoL scores than those who were robust after controlling for sociodemographic and health-related characteristics (BT = −0.04, p < 0.001). Researchers need to consider older adults’ social frailty as well as health status and sociodemographic status in future interventions to improve the HRQoL of older adults.

The Relationship between Living Arrangements and Sleep Quality in Older Adults: Gender Differences

(1) Background: This study examined the effects of living arrangements on the quality of sleep among older adults and analyzed related gender differences; (2) Methods: A total of 4756 older adults in Seoul were included. After adjusting for socio-demographic factors, older adults living alone showed a poorer sleep quality compared with those living with others; (3) Results: When we analyzed the effects of living arrangements on sleep quality by gender, there was no difference in the risk of poor sleep quality between male older adults living alone and those living with others (OR = 1.089, 95% CI = 0.729–1.628), whereas the risk of poor sleep quality was higher for female older adults living alone than those living with others (OR = 1.359, 95% CI = 1.088–1.696); (4) Conclusions: In this study, we have confirmed that older women living alone had poor sleep quality compared to older men. Hence, gender-based approaches will be helpful when providing social support resources to older adults living alone.

Network and solitude satisfaction as modifiers of disadvantages in the quality of life of older persons who are challenged by exclusion from social relations: a gender stratified analysis

This study examined from a gender-sensitive perspective the associations of exclusion from social relations (ESR) with the quality of life (QoL) of excluded older persons. Being satisfied with existing relations (i.e., network satisfaction) may be particularly important for the QoL of older persons with small networks, whereas the QoL of "network-less" older persons may be associated with their perception of solitude (i.e., solitude satisfaction). This study examined the moderating role of network satisfaction (NS) in the gendered associations between network size and QoL, as well as the gendered associations of solitude satisfaction (SS) with the QoL of older "network-less" persons. In addition, the comparative disadvantages in the QoL of "network-less" older persons with low-to-high SS, compared to the QoL of socially embedded persons with low-to-high NS were examined. Cross-sectional gender stratified secondary analyses of data from participants (N = 72.433) in the Survey on Health, Aging and Retirement in Europe (SHARE) did not provide convincing evidence that a higher NS is particularly important for the QoL of older persons with smaller networks. Among older "network-less" persons, lower SS was associated with lower QoL, comparatively more so among older women. Older persons embedded in a social network with low NS, as well as older "network-less" persons with low SS, have comparatively the lowest levels of QoL. It was concluded that the subjective evaluation of social relations and the subjective evaluation of solitude are associated with gendered disadvantages in the QoL of older persons challenged by ESR.

Correlation between functional disability and quality of life among rural elderly in Anhui province, China: a cross-sectional study

Objective

We aimed to explore the correlation between functional disability and quality of life (QoL). And exploring the interaction of functional disability, basic demographic characteristics and health-related information on QoL among the rural elderly in Anhui Province.

Methods

This study used multi-stage stratified cluster sampling in rural Anhui Province from January to July 2018 to conduct a cross-sectional survey of older adults who met the inclusion criteria. The Five-Dimensional European Quality Of Health Scale (EQ-5D) and the WHO Disability Assessment Schedule (WHODAS2.0) scale were used to evaluate the QoL and functional disability, and the basic demographic characteristics of the survey subjects were also collected. Using binary logistic and Classification and regression tree model (CART) models to analyze the data, explore the relationship between functional disability and QoL in the elderly.

Results

A total of 3491 older adults were included in the survey, and 3336 completed the entire survey, with an effective response rate of 95.56%. After adjusting for covariables, those who had limited in dimension of mobility (AOR=2.243, 95%CI: 1.743-2.885), getting along (AOR=1.615, 95%CI: 1.173-2.226), life activities (AOR=2.494, 95%CI:1.928-3.226), and social participation (AOR=2.218, 95%CI: 1.656-2.971) had a lower QoL. However, the dimension of cognition (AOR=0.477, 95%CI: 0.372-0.613) is a protective factor for QoL. Additionally, we also observe that 96.3% of those who were unemployed and limited in both mobility and life activities dimensions had a lower QoL, but among those who were robust in both mobility and social participation dimensions and not suffer from chronic diseases, 56.3% had a higher QoL.

Conclusions

Our findings indicate that special attention should be paid to the elderly who are unemployed, have limited in cognition, getting along, social participation, mobility, life activities and cognition robust to improve their QoL. This research is of great significance for formulating targeted strategies and measures to improve the QoL for rural elderly.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12363-7.

Quality of life of older adults and associated factors in Ghanaian urban slums: a cross-sectional study

OBJECTIVE

This study provides insight into the quality of life (QoL) of older adults living in urban slums in Ghana.

DESIGN

The study employed a community-based, cross-sectional design to assess QoL among older adults in two slums between April and May 2020. QoL was assessed using the WHO Quality of Life-Brief version (WHOQOL-BREF) questionnaire.

SETTINGS

Participants were drawn from two slums in Ghana, one in a fishing-dominated community and the other in an industrial community.

PARTICIPANTS

This study included 400 participants aged 60 and above who had lived in either slum for at least 1 month and were able to communicate verbally.

RESULTS

Although the means of all participants' transformed scores were poor in the physical and psychological domains, they were moderate in all other domains. When viewed as a whole, the perceived overall QoL is neither poor nor good and participants were neither satisfied nor dissatisfied with their health. Participants had a moderate level of QoL in the WHOQOL-BREF psychological (mean score 45.7), social (mean score 57.0) and environmental (mean score 51.6) domains. The mean score for physical QoL of older adults was 43.3, which denotes poor QoL. In all domains, male participants have a significantly higher mean QoL than their female counterparts. An analysis of variance comparing the living arrangements of participants showed that those who lived with extended family had high mean scores in environmental QoL, overall QoL and satisfaction with health. Regression analysis revealed that QoL was influenced mostly by the environmental (46.2%), followed by the psychological (43.7%), physical (31%) and social (20.4%) domains.

CONCLUSIONS

The findings from this study show that older adults living in slums had moderate psychological, social and environmental QoL and poor physical QoL. Although the mean scores for QoL are higher than anticipated, health policy development must take into account the specific needs of older adults.

The impact of loneliness and social isolation on health state utility values: a systematic literature review

Background

Loneliness and social isolation are recognised as social problems and denote a significant health burden. The aim of this study was to conduct a systematic literature review to explore the health state utility values (HSUVs) associated with loneliness and/or social isolation.

Method

Peer-reviewed journals published in English language that reported both HSUVs along with loneliness and/or social isolation scores were identified through five databases. No restrictions were made relating to the population, study design or utility estimation method used.

Results

In total, 19 papers were included; 12 included a measure of loneliness, four studies included a measure of social isolation and three studies considered both loneliness and social isolation. All studies focused on individuals with pre-existing health conditions—where the EQ-5D-3L instrument was most frequently used to assess HSUVs. HSUVs ranged from 0.5 to 0.95 in those who reported not being lonely, 0.42 to 0.97 in those who experienced some level of loneliness, 0.3 to 0.87 in those who were socially isolated and 0.63 to 0.94 in those who were not socially isolated.

Conclusion

There was significant variation in HSUVs complicated by the presence of co-morbidities, population heterogeneity, variations in methods used to derive utility scores and differences in the measurement of loneliness and/or social isolation. Nevertheless, the lower HSUVs observed should be considered to significantly impact quality of life, though we also note the need for further research to explore the unique impact of loneliness and social isolation on HSUVs that can be used in the future economic evaluations.

Vulnerability and quality of life of older persons in the community in different situations of family care

OBJECTIVE

to correlate socio-contextual aspects, physical vulnerability and quality of life of older persons in the community in different situations of family care.

METHODS

epidemiological, a cross-sectional and analytical study, with elderly people in the community (n=769), with application of the instruments: Vulnerable Elders Survey-13 (VES-13), World Health Organization Quality of Life for Older Persons (WHOQOL-OLD) and the World Health Organization Quality of Life (WHOQOL-BREF); and socio-contextual data questionnaire.

RESULTS

the population assessed presented an average of regular quality of life in both the WHOQOL-BREF and the WHOQOL-OLD. Older non-vulnerable persons (62.2%) and those with close family contact (82.6%) have a better quality of life than the vulnerable (p<0.0001).

CONCLUSION

lower quality of life scores and more distant families are related to vulnerable elderly people; thus, the assessment of family proximity and physical vulnerability of older persons is shown to be an important factor in improving quality of life.